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Its divided into two main groups. The paralytic obstruction i.e.: (paralytic
Ileus) & mechanical (dynamic) obstruction.
Mechanical obstruction is further classified according to the speed of
onset, the site, the nature & aetiology.
The proximal part is distended & distention is by two factors. (gas &fluid)
*Gas comes form three sources:
1-swallowed atmospheric air.
2-diffusion from blood to intestinal lumen.
3-product of digestion& bacterial activity.
The gas is made up of mixture of Nitrogen& Hydrogen sulphide(H2S) .
The O2 & CO2 will be absorbed to the blood stream.
*fluid is made up of two sources:
1-what the patient ingest & drink.
2-digestive secretion: saliva, gastric juice, bile, pancreatic secretion ,&succus
entericus.
O/E:
-the patient is dehydrated if there is large amount of vomiting had occurred.
-the patient is in pain & rolling on the bed.
-tachycardia.
-temperature usually is normal but if temperature is this suggest strangulation.
-abdomen is distended &there may be visible peristalsis.
-hernial orifices should be examined.
-look to the abdominal wall for any previous scar which suggest adhesions or
band.
The non viable segment can be resected safety with doing end to end
anastomosis.
In large bowel the segment resected and proximal colostomy done
with doing end to end anastomosis.
OR: the segment resected and both ends taken out as double burrel
colostomy.
OR: only proximal colostomy done and later resection done.